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A 57-year-old corporate executive, married with three grown children, began suffering from severe flu-like symptoms and weight loss. Hospitalized for a week, he was tested for chronic fatigue syndrome and mononucleosis. Finally, with no change in his symptoms, his physician recommended an HIV test. The results were positive.

During the 1989 gubernatorial race, Jim Florio liked to say that a political campaign is a conversation--a time for candidates and voters to communicate aspirations and concerns, an opportunity for political engagement and dialogue. An election campaign is a time when citizens pay more attention to politics, and candidates have more personal contact with voters. For both citizens and candidates, a campaign at its best is a time for education.

At first glance, there would seem to be little controversy over cardiac catheterization, a diagnostic procedure used to evaluate problems with heart function and blood supply. In a typical cardiac catheterization, a long thin tube is inserted through blood vessels into the heart to evaluate blood pressure, inject dye, and take x-rays.

The tremors that are shaking the world of medicine are reshaping the landscape of graduate medical education (GME), and along with it, the future of the medical profession in the United States. GME--essentially medical residencies and, to a lesser extent, research fellowships--is the crossroads where career aspirations become professional choices, and where decisions are made, both on a macro and micro level, that will shape medicine for years to come.

John Adessa is unhappy with the direction managed care has taken in this country, and he is doing something about it. Adessa, the chief executive officer of First Option Health Plan, dislikes the burden of risk that falls on physicians through capitation arrangements, and he does not believe that patients should be severely restricted in their access to physicians.